Flexible endoscopic support system

ABSTRACT

A scope system is provided including an elongate tube with a distal portion and a lumen extending therethrough. The scope system also includes at least one accessory channel including a tubular structure with an accessory lumen extending therethrough, the at least one accessory channel movably disposed at least partially within the lumen of the elongate tube. The at least one accessory channel includes a distal section and a forward-viewing configuration and a side-viewing configuration. In the forward-viewing configuration, the distal section of the at least one accessory channel is substantially parallel to the distal portion of the elongate tube and in the side-viewing configuration, the distal section of the at least one accessory channel is arced at a radius greater than a radius of the distal portion of the elongate tube.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present patent document is a divisional application of U.S.Non-Provisional patent application Ser. No. 15/445,318, filed Feb. 28,2017, which is hereby incorporated by reference. The present patentdocument also claims the benefit of the filing date under 35 U.S.C. §119(e) of Provisional U.S. Patent Application Ser. No. 62/301,705 filedMar. 1, 2016, which is hereby incorporated by reference.

FIELD

The present disclosure relates to medical devices and more specificallyto endoscope systems.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

The duodenoscope is a medical device used in a variety of endoscopicprocedures, including endoscopic retrograde cholangio-pancreatography(ERCP). In an ERCP, a physician inserts the duodenoscope into apatient's mouth, through the patient's gastrointestinal (GI) tract, andinto the duodenum until the distal end of the duodenoscope is positionednear the papilla of Vater, a small mound-like structure that acts as theentrance from the common bile duct and pancreatic duct into theduodenum. The physician then uses a variety of tools and accessoriesthat are passed through a lumen in the duodenoscope to access the commonbile duct or pancreatic duct through the papilla of Vater.

However, the duodenoscope suffers from several design issues. Forexample, due to the location of the papilla of Vater and shape of theduodenoscope, the endoscope tools or accessories must be bent sharply at(or sometimes more than) 90 degree angles at the distal end of theduodenoscope, which results in significant friction between the toolsand duodenoscope and accompanying force transmission loss. Therefore,the accessories must be durable enough to withstand this sharp bend andthe physician must apply a greater force to continue to advance thetools than is desired. Further, the built-in camera system of theduodenoscope is side-facing, making it difficult for novices and evenexperienced physicians to navigate the duodenoscope through the GItract. Also, traditional duodenoscopes only have one accessory channel,making the use of multiple accessories time intensive and cumbersome.Additionally, duodenoscopes are difficult to clean, which may result ininadequate cleaning of the device after use and potential bacterialcontamination of patients during subsequent use of the duodenoscope.

Therefore, it is desirable to have an endoscope system that eliminatesor lessens the force transmission losses of traditional duodenoscopes.Further, increased and easier maneuverability of an endoscope systemthrough and within the GI tract is desired. It is also desirable toprovide an endoscope system that is easy to clean or is disposable.

SUMMARY

In one form of the present disclosure, a scope system is provided. Thescope system comprises an elongate tube comprising a lumen extendingtherethrough, the elongate tube further comprising a distal portion. Thescope system also comprises at least one accessory channel comprising atubular structure comprising an accessory lumen extending therethrough,the at least one accessory channel movably disposed at least partiallywithin the lumen of the elongate tube, the at least one accessorychannel comprising a distal section, the at least one accessory channelfurther comprising a forward-viewing configuration and a side-viewingconfiguration. Additionally, in the forward-viewing configuration, thedistal section of the at least one accessory channel is substantiallyparallel to the distal portion of the elongate tube, and in theside-viewing configuration, the distal section of the at least oneaccessory channel is arced at a radius greater than a radius of thedistal portion of the elongate tube.

The at least one accessory channel of the scope system may also bemovable in a distal direction which moves the at least one accessorychannel from the forward-viewing configuration to the side-viewingconfiguration and the at least one accessory channel may be movable in aproximal direction which moves the at least one accessory channel fromthe side-viewing configuration to the forward-viewing configuration. Thescope system may further include the distal portion comprising a pivotpoint, wherein during movement of the at least one accessory channelbetween the forward-viewing configuration and the side-viewingconfiguration, the at least one accessory channel rotates about thepivot point. The scope system may also comprise an axially rotatablebearing disposed between the distal portion of the elongate tube and aproximal portion, the axially rotatable bearing permitting rotation ofthe distal portion with respect to the proximal portion. The scopesystem may also further comprise first and second drive membersconnected to the distal portion of the elongate tube and extendingproximally along the elongate tube, wherein proximal movement of thefirst drive member bends the distal portion of the elongate tube in afirst direction, and proximal movement of the second drive member bendsthe distal portion of the elongate tube in a second direction. Thesystem may further comprise a light connected to the distal portion,wherein one of the first and second drive members further comprises anelectrical wiring between the light and a power source.

In another form of the present disclosure, a scope cap is provided. Thescope cap comprises a housing comprising an attachment portion, theattachment portion configured to engage with a scope, the housingfurther comprising a pivot point. The scope cap also comprises at leastone accessory channel engaged with the housing, the at least oneaccessory channel comprising a tubular structure comprising an accessorylumen extending therethrough, the at least one accessory channel furthercomprising a distal section and a proximal section, wherein the proximalsection is configured to removably engage with the scope. Further, thedistal section of the at least one accessory channel is rotatable aboutthe pivot point to move the at least one accessory channel between aside-viewing configuration and a forward-viewing configuration.

The at least one accessory channel of the scope cap may also be rotatedat least 45 degrees in the side-viewing configuration with respect tothe distal section of the at least one accessory channel when in theforward-viewing configuration. Additionally, movement of the at leastone accessory channel in a proximal direction may move the at least oneaccessory channel from the forward-viewing configuration to theside-viewing configuration, and movement of the at least one accessorychannel in a distal direction may move the at least one accessorychannel from side-viewing configuration to the forward-viewingconfiguration.

In yet another form of the present disclosure, a method is provided. Themethod comprises inserting the scope system into a patient's body, thescope system comprising an elongate tube comprising a lumen extendingtherethrough and at least one accessory channel movably disposed atleast partially within the lumen of the elongate tube, the at least oneaccessory channel comprising a tubular structure comprising an accessorylumen extending therethrough. The method further comprises positioningthe scope system in a forward-viewing configuration, wherein in theforward-viewing configuration a distal section of the at least oneaccessory channel is substantially parallel to a distal portion of theelongate tube. Also, the method comprises moving the scope system to aside-viewing configuration, wherein in the side-viewing configuration,the distal section of the at least one accessory channel is arced at aradius greater than a radius of the distal portion of the elongate tube.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 is a drawing of an endoscope system;

FIG. 2 is a detailed view of the distal portion of an endoscope systemin a forward-facing configuration;

FIG. 3 is a detailed view of a pivot arm in a forward-facingconfiguration;

FIG. 4 is a detailed view of a pivot arm in a side-facing configuration;

FIG. 5 is a detailed view of the distal portion of an endoscope systemin a side-facing configuration;

FIG. 6 is a detailed view of the distal portion of an endoscope systemin a bent configuration;

FIG. 7 is a cross-sectional view of a rib of an endoscope system;

FIG. 8 is a detailed view of the distal portion of an endoscope systemin a bent and side-facing configuration;

FIG. 9 is a detailed view of an axially rotatable bearing of anendoscope system;

FIG. 10 is a detailed view of a handle of an endoscope system;

FIG. 11 is a pictorial representation of an endoscope system in use;

FIG. 12 is another pictorial representation of an endoscope system inuse;

FIG. 13 is another pictorial representation of an endoscope system inuse;

FIG. 14 is a drawing of an endoscope cap in a forward-viewingconfiguration; and

FIG. 15 is a drawing of an endoscope cap in a side-viewingconfiguration.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features. Itshould also be understood that various cross-hatching patterns used inthe drawings are not intended to limit the specific materials that maybe employed with the present disclosure. The cross-hatching patterns aremerely exemplary of preferable materials or are used to distinguishbetween adjacent or mating components illustrated within the drawingsfor purposes of clarity.

Referring to FIG. 1, an endoscope system 10 is provided. The endoscopesystem 10 may be generally shaped as an elongate tube including a distalportion 12, a central portion 14, and a proximal, or handle, portion 13.The central portion 14 may be a flexible, elongate tube with at leastone lumen 15 running throughout the length of the central portion 14.The central portion 14 may connect the distal portion 12 and proximalportion 13 together. The lumen 15 of the central portion 14 may extendthrough the distal 12 and handle portions 13 of the endoscope system 10as well. The central portion 14 may be made of a braided material suchas pebax with a polytetrafluoroethylene liner to provide sufficienttorqueability and pushability. Other potential materials for the centralportion 14 include but are not limited to polyethylene, polypropylene,and nylon. The endoscope system 10 may further include two accessorychannels 16, 18 each with lumens 17, 19 running therethrough (shown inFIG. 7). The accessory channels 16, 18 may be designed as individualelongated tubes that may be movable within the lumen 15 of the system10, thus allowing longitudinal movement of the accessory channels 16, 18with respect to the central portion 14. While this embodiment includestwo accessory channels 16, 18, one or even three or more accessorychannels may be used. For example, a single, larger accessory channelmay be used to accommodate larger endoscopic tools. Further, in lieu ofindividual accessory channels 16, 18, a single elongate tube may be usedwith two or more lumens running through it. The accessory channels 16,18 may range in diameter anywhere from 1 to 10 millimeters. In oneexemplary embodiment, the first accessory channel 16 may be 4.2millimeters in diameter while the second accessory channel 18 may be 3.7millimeters in diameter. The accessory channels 16, 18 may extendproximally from or past the handle portion 13, through the lumen 15 andinto the distal portion 12. Various tools, devices, and cameras may beinserted into and removed from the accessory channels 16, 18.

Now referring to FIG. 2, a detailed view of the distal portion 12 of theendoscope system 10 is shown. The endoscope system 10 may include arotational bearing 20 disposed between the central portion 14 and thedistal portion 12, which allows the distal portion 12 to rotateindependently of the central portion 14. The distal portion 12 may havea flexible rib-like construction with multiple individual ribs 22connected together to create an elongate tube with a lumen 15. Theseribs 22 may be made of a variety of materials, such as polycarbonate,nylon, polyethylene, polypropylene, and polyoxymethylene. The accessorychannels 16, 18 may travel through the ribs 22 to the distal end section24 of the distal portion 12. The distal end section 24 may include apivot arm 26 with first and second accessory lumens 28, 30 (shown inFIGS. 3 and 4). The distal ends of the accessory channels 16, 18 may befixedly or movably disposed within respective accessory lumens 28, 30.The distal end section 24 may also include a side port 32 that providesaccess from the lumen 15 to a point external the endoscope system 10.

The distal end section 24 of the distal portion 12 is shown in moredetail in FIGS. 3 and 4. For clarity, the accessory channels 16, 18 areomitted from FIGS. 3 and 4. The pivot arm 26 may be connected to thedistal end section 24 via a pin 34. The pin 34 may create a pivot point,around which the pivot arm 26 may rotate with respect to the distal endsection 24 to the position shown in FIG. 4. The pivot arm 26 may bemoved between a forward-viewing position as shown in FIG. 3 and aside-viewing position as shown in FIG. 4. A LED light 35 may be placedon the distal end section 24 to assist in navigation through a patient'sGI tract. Alternatively, the LED light 35 may be placed at otherlocations on the distal end section 24, such as near the side port 32.Also, multiple LED lights 35 may be used at various locations on thesystem 10.

As shown in FIGS. 2 and 5, the distal ends of the accessory channels 16,18 may be secured to the pivot arm 26. Therefore, the accessory channels16, 18 may rotate with the pivot arm 26 when moving the pivot arm 26between the side-viewing and forward-viewing configurations. FIG. 2shows the accessory channels 16, 18 in the forward-viewingconfiguration, while FIG. 5 shows the accessory channels 16, 18 in theside-viewing configuration. As can be seen in FIG. 5, when in theside-viewing configuration and due to the rotation of the pivot arm 26,distal portions of the accessory channels 16, 18 are bent outside of theconfines of the ribs 22 and then curve back towards and into the pivotarm 26. Thus, in the forward-viewing configuration, the angle ofcurvature or bending radius of the distal portion 12 is the same as theangle of curvature of the accessory channels 16, 18 such that theaccessory channels 16, 18 and the distal portion 12 of the scope system10 are substantially parallel; but in the side-viewing configuration,the angle of curvature or bending radius of the accessory channels 16,18 is greater than the angle of curvature of the distal portion 12 suchthat distal portions of the accessory channels 16, 18 extend outside thelumen 15 of the distal portion 12. To facilitate movement between thetwo configurations, the ribs 22 may have a U or V-shaped design with anopen section that allows the accessory channels 16, 18 to move freely inand out of the ribs 22 (best shown in FIG. 7).

To move the pivot arm 26 from the forward-viewing position to theside-viewing position, the accessory channels 16, 18 may be pushed in adistal direction relative to proximal portion 13 and central portion 14,which applies a force through the accessory channels 16, 18 to the pivotarm 26. The resulting force causes the pivot arm 26 to rotate about thepivot point of the pin 34, thereby moving the accessory channels 16, 18and pivot arm 26 into the side-viewing configuration. To move back tothe forward-viewing configuration, a proximal force may be applied tothe accessory channels 16, 18 relative to proximal portion 13 andcentral portion 14, thereby transferring the proximal force to the pivotarm 26. The proximal force then causes the pivot arm 26 to again rotatearound the pivot point of the pin 34 in the opposite direction, therebymoving the accessory channels 16, 18 and the pivot arm 26 back to theforward-viewing configuration. To ensure that the accessory channels 16,18 move in unison during these movements, the accessory channels 16, 18may be secured together at any point along the length of the system 10,or even along the entire length. In one example, the accessory channels16, 18 may be secured together using plastic tubing throughout theentire length of the central portion. In another example, the accessorychannels 16, 18 may be secured together at the portions of the accessorychannels 16, 18 that extend outside the constraints of the distalportion 12 when the system 10 is in the side-viewing configuration.

While this embodiment describes the use of a pivot arm 26 to assist intransferring the accessory channels 16, 18 between forward-viewing andside-viewing configurations, a variety of other methods and structuresmay be used. Further, rather than using a single pivot arm 26, multiplepivot arms may be used, or one for each accessory channel 16, 18.Therefore, each accessory channel 16, 18 may be moved between theforward-viewing and side-viewing configurations independently of eachother. Further, the degree of rotation of the pivot arm 26 between theforward-viewing and side-viewing configuration may vary, potentialranging from 45 degrees to greater than 135 degrees.

In addition to the ability to switch between forward-viewing andside-viewing configurations, the distal portion 12 of the endoscopesystem 10 may also bend and rotate as desired. FIG. 2 shows the distalportion 12 in a straight configuration, while FIG. 6 shows the distalportion 12 in a bent configuration. The endoscope system 10 may includea first drive member 36, a second drive member 38, and a third drivemember 39 (shown in FIG. 7). The second and third drive members 38, 39may extend through the ribs 22 in the same plane of FIGS. 2 and 6, soonly the second drive member 38 is representatively shown in thosefigures. FIG. 7 shows one potential orientation of the three drivemembers 36, 38, 39 in a cross-sectional view. The drive members 36, 38,39 may be fixedly attached to the distal end section 24 and extendthrough, or outside of the lumen 15 to the handle portion 13.Alternatively, the drive members 36, 38, 39 may extend through dedicatedlow friction lumens or catheters along the length of the endoscopesystem 10 to the handle 13. The first drive member 36 may be fixed on awall of the distal end section 24 while the second and third drivemembers 38, 39 may be fixed on an opposing wall of the distal endsection 24 with respect to the first drive member 36. To move the distalportion 12 from the straight configuration shown in FIG. 2 to the bentconfiguration shown in FIG. 6, the first drive member 36 may be pulledin a proximal direction. This proximal movement of the first drivemember 36 may result in a force being applied through the first drivemember 36 and to the distal end section 24. This force may cause theflexible, ribbed body of the distal portion 12 to bend towards theconfiguration shown in FIG. 6. To move the distal portion 12 back to thestraight configuration, the second and third drive members 38, 39 may bepulled in a proximal direction. Since the second and third drive members38, 39 are connected to the opposite side of the distal end section 24,a force is applied through the second and third drive members 38, 39 andto the distal end section 24 that may move the distal portion 12 backtowards the straight configuration.

The drive members 36, 38, 39 may also be used to secure the individualribs 22 of the distal portion 12 together, as shown in thecross-sectional view of an individual rib 22 in FIG. 7. The drivemembers 36, 38, 39 may run through small holes 37 in each individual rib22, and sufficient tension may be applied to the drive members 36, 38,39, thereby securing the ribs 22 together along the drive members 36,38, 39. Due to this design, the ribs 22 may be shaped to allow forminimal contact between the individual ribs 22. For example, the ribs 22shown in this embodiment have a substantially U-shaped cross-sectionwith an opening and two sides. Each side of the ribs 22 may be diamondshaped when viewing the system 10 from a side angle (as best seen inFIGS. 3-4). The diamond shape reduces the contact points between eachrib, thus minimizing friction and allowing for easier bending of thedistal portion 12 to the bent configuration and maximum flexibility.Optionally, the second or third drive members 38, 39 may also includebuilt-in electrical wiring that allows the second or third drive members38, 39 to function as a circuit for the LED light 35 as well. Further,while this embodiment only describes the use of three drive members 36,38, 39 more or less drive members may be used as desired. Alternativelyor in addition to the drive members 36, 38, 39, the ribs 22 may beconnected together using a variety of other methods, such as withmechanical hinges, adhesives, and other well-known devices. Further,additional elongate members may extend through the ribs 22 similar tothe drive members 36, 38, 39 to provide additional support to the distalportion 12.

Additionally, the ribs 22 may be covered by a protective sleeve that maybe made up of various biocompatible materials, such as an elastomericmaterial. The protective sleeve may protect the ribs 22 while alsopreventing body tissue from accidentally being pinched between theindividual ribs 22 when the distal portion 12 is moved between the bentconfiguration and the straight configuration. The protective sleeve mayalso include a slot that corresponds to the openings in the ribs 22 thatallows the accessory channels 16, 18 to move outside of the protectivesleeve and between the forward-viewing configuration and theside-viewing configuration. The protective sleeve may also help withtorque transmission when moving the distal portion 12 between the bentand straight configurations. Some natural lag may occur whenmanipulating the drive members 36, 38, 39 that may cause part of thedistal portion 12 to move first, while the rest of the distal portionlags behind, but eventually moves as well. The protective sleeve mayensure that the entire distal portion 12 moves together and with minimallag.

The endoscope system 10 may move between a bent configuration and astraight configuration while the endoscope system 10 is also in eitherthe forward-facing or side-facing configurations. For example, FIG. 8shows the endoscope system 10 in a bent and side-facing configuration.The endoscope system 10 can be manipulated and used in any combinationof the above mentions configurations, and may be repeatedly movablebetween all configurations.

The accessory channels 16, 18 may be used to provide access for avariety of medical tools and accessories through the endoscope system 10and into a patient's body. For example, a camera system may be insertedinto one of the accessory channels 16 while a variety of tools such asforceps, sphincterotomes, wires, dilation balloons, extraction balloons,stents, needle knives, hemostasis clips, and any other catheter basedtool may be inserted into the second accessory channel 18. The tools maybe advanced past the distal ends of the accessory channels 16, 18 wherethey may be used to operate on a patient.

FIG. 9 shows a cross-sectional view of the axially rotatable bearing 20and its functionality. The axially rotatable bearing 20 may include afirst ring 50 and a second ring 52. The axially rotatable bearing 20 mayfurther include a first tube 54 and a second tube 56. The first tube 54may be fixedly attached to the central portion 14 and the first ring 50.The second tube 56 may be fixedly attached to the distal portion 12 andthe second ring 52. The first tube 54 and first ring 50 may be freelyrotatable with respect to the second tube 56 and second ring 52, therebymaking the distal portion 12 freely rotatable with respect to thecentral portion 14. Since the first ring 50 is indirectly secured to thecentral portion 14, but is located distal the second ring 52 which isindirectly secured to the distal portion 12, the distal portion 12 andcentral portion 14 may remain secured to each other while stillremaining freely rotatable with respect to each other. The distalportion 12 may be freely rotated when the endoscope system 10 is in anyone of the configurations described above, including forward-facing,side-facing, straight, and bent configurations. The accessory channels16, 18 and the drive members 36, 38, 39 may pass freely through thelumen 15 of the bearing with causes no or minimal interference to thebearing 20. This is merely one potential design for the axiallyrotatable bearing 20, and various other designs that allow free rotationof the distal portion 12 with respect to the central portion 14 may beused.

Now referring to FIG. 10, a detailed view of the handle portion 13 ofthe endoscope system 10 is shown. The handle 13 may include severalcontrols used to manipulate the distal portion 12 of the endoscopesystem 10. The handle 13 may be include a first portion 40 and a secondportion 42, where the first portion 40 is freely rotatable with respectto the second portion 42. The handle 13 may include an arm 44 that isconnected to the first drive member 36, which is further connected tothe distal end section 24. The arm 44 may be moved and/or pivoted in aproximal direction, which causes the first drive member 36 to be pulledin a proximal direction, thereby applying a proximal force to the distalend section 24 and causing the distal portion 12 to bend as shown inFIG. 6. The handle 13 may further include a first slider 46, which maybe connected to the second and third drive member 38, 39, which isfurther connected to the distal end section 24. Similarly to the arm 44,the first slider 46 may be moved in a proximal direction which resultsin a proximal force being applied to the distal end section 24 throughthe second and third drive members 38, 39, thereby causing the distalportion 12 to bend back towards, and even past, the position shown inFIG. 2.

The handle 13 may further include a second slider 48, which may be slidalong a slot 47 in a proximal and distal direction. The second slider 48may be connected to the first and second accessory channels 16, 18,where proximal or distal movement of the second slider 48 causescorresponding movement of the first and second accessory channels 16,18. Therefore, moving the second slider 48 in a distal direction causesthe accessory channels 16, 18 to move in a distal direction, therebycausing the pivot arm 26 to rotate and move into the side-viewingconfiguration. Further, moving the second slider 48 in a proximaldirection causes the pivot arm 26 to rotate back towards theforward-viewing configuration. Also, as discussed earlier, the firstportion 40 may be rotated freely with respect to the second portion 42.Since the accessory channels 16, 18 are fixed to the second slider 48,rotation of the first portion 40 may cause corresponding rotation of theaccessory channels 16, 18. Since, the accessory channels 16, 18 are alsofixed at their distal ends to the pivot arm 26, which is in turn fixedto the rest of the distal portion 12 of the system 10, rotation of thefirst portion may cause corresponding rotation of the entire distalportion 12. Further, since the axially rotatable bearing 20 as shown inFIG. 9 is disposed between the distal portion 12 and central portion 14,the distal portion 12 may rotate in response to rotation of the firstportion 40 of the handle 13 without the rest of the system 10 rotating.Additionally, a knob 49 may be used to control the brightness or powerof the LED light 35, which is wired to the knob 49 at least partiallythrough the second and/or third drive members 38, 39.

The handle 13 is merely one potential embodiment of the handle portion13, and any other handle design capable of controlling the endoscopesystem 10 may be used, including variations on the arms or sliders thatcontrol various features of the system 10. For example, the handle 13and various controls such as the arm 44 and sliders 46, 48 may includelocking elements that lock the system in the various aforementionedconfigurations. In one example, the handle 13 may include frictionallocks, where the various arms and sliders may be maintained in theircurrent position with a frictional force. However, the application of anexternal force may still move the controls as desired. In anotheralternative handle 13 design, the arm 44 may have a pivot point in thecenter of the handle, with one end of the arm 44 connected to the firstdrive member 36 and the other end of the arm 44 connected to the secondand third drive members 38, 39, thus allowing the arm 44 to control bothdirections of bending motion for the distal portion 12.

The endoscope system 10 described herein may be used for a variety ofmedical procedures. However, one such procedure, an endoscopicretrograde cholangiopancreatography (ERCP), is now described withreference to FIGS. 11-13. The endoscope system 10 may be inserted into apatient's mouth and through the gastrointestinal tract. It may bepreferable to insert the endoscope system 10 in the forward-facingposition, which provides a lower profile than the side-facing position,thus making advancement through the gastrointestinal tract easier.Further, a camera system 70 may be inserted into one of the accessorychannels 16 to assist the physician in guiding the endoscope system 10through the patient's gastrointestinal tract. The camera system 70 maybe integral with the accessory channel 16, or it may be advanceable pastthe distal end of the accessory channel 16. Further, the camera system70 may include a light source independent of the rest of the system 10.The camera system 70 may be positioned in the accessory channel 16 suchthat the distal end of the camera system extends into or just past thepivot arm 26, thus providing a clear view of the distal end of theendoscope system 10 as it is advanced. The endoscope system 10 may beadvanced past the stomach and into the duodenum D until the distal endsection 24 is disposed near the papilla of Vater P as shown in FIG. 11.

Once the distal end section 24 is disposed near the papilla of Vater P,the distal portion 12 may be bent or straightened using the arm 44 andfirst slider 46 of the handle 13 until the distal end section 24 issubstantially perpendicular to the papilla of Vater P. The distalportion 12 may further be rotated by the first portion 40 of the handle13 so that the side port 32 is aimed towards the papilla of Vater P. Theaccessory channels 16, 18 may next be moved from the forward-facingconfiguration to the side-facing configuration by moving the secondslider 48 of the handle 13 in a distal direction until the pivot arm 26rotates to the side-facing configuration. The distal portion 12 may befurther manipulated by the controls of the handle 13 until the distalend section 24 is properly positioned with relation to the papilla ofVater P as shown in FIG. 12. In this position, the accessory channels16, 18 have a direct and straight line of access to the papilla of VaterP. FIG. 12 further shows at least one of the accessory channels 16, 18contacting the wall of the duodenum D opposite the papilla of Vater P.This contact helps push the entire endoscope system 10 closer to thepapilla of Vater P and provides an anchor point to help secure theendoscope system 10 within the duodenum or other target portion of theanatomy.

At this point, a variety of tools may be used to access the pancreaticduct D or the common bile duct C through the papilla of Vater P. If acamera system 70 was used previously, it may optionally be removed toallow for additional tools to be used. The gradual, curved path of theaccessory channels 16, 18 may reduce friction between the accessorychannels 16, 18 and tools, thus reducing the amount of force requiredfor the physician to advance the tools towards the papilla of Vater P.For example, the sphincter of Oddi, a strong muscle found within thepapilla of Vater P, may need to be dilated or cut to allow access intothe common bile duct CBD or pancreatic duct PD. Therefore, asphincterotome 72, a long tool with a thin wire capable of cuttingthrough the sphincter of Oddi, may be advanced through the accessorychannel 18 and towards the papilla P as shown in FIG. 13. Thesphincterotome 72 may then be used to cut into the sphincter of Oddi,therefore creating an access point into the common bile duct CBD andpancreatic duct PD. Physicians often have difficulty properlypositioning the sphincterotome 72 or other dilation tools towards thesphincter and providing sufficient force to the sphincter. The accessorychannels 16, 18 contacting the opposite wall of the duodenum D providesan anchor point that may allow the physician to apply a sufficientamount of force to the sphincterotome 72 or other tools without fear oflosing positioning of the endoscope system 10. Once an access point hasbeen created, a variety of tools, including the camera system 70,radiopaque dye injector, kidney stone retriever, etc. may be advancedthrough either of the accessory channels 16, 18 and into the common bileduct CBD or pancreatic duct PD.

Following completion of the procedure, the various tools used may bewithdrawn and the endoscope system 10 may be moved to the straightconfiguration and the forward-viewing configuration, thus permitting thephysician to remove the endoscope system 10 from the patient's body insubstantially the same was as it was inserted.

In a second embodiment shown in FIG. 14, a scope cap 100 may beattachable to a standard duodenoscope or endoscope. The scope cap 100has many of the features of the aforementioned embodiments. The scopecap 100 may be removably or fixedly attached to a duodenoscope 102 usinga variety of methods, including a friction fit, elastic belt, andadhesives. Alternatively, the scope cap 100 may be attached to anendoscope, cholangioscope, or any other similar devices. The endoscopecap 100 may include a pivot arm 104. The pivot arm 104 may be similar tothe pivot arm described in previous embodiments, with a pin 106 creatinga pivot point around which the pivot arm 104 may rotate with respect tothe rest of the scope cap 100. The pivot arm 104 may further include afirst pivot lumen 108 and a second pivot lumen 110. A first accessorychannel 112 and a second accessory channel 114, each with respectivelumens, may be connected to the respective pivot lumens 108, 110. Theaccessory channels 112, 114 may run from the pivot arm 104, along theoutside of the duodenoscope 102, and to or near the proximal end of theduodenoscope 102. Multiple clips 116 (only one shown in FIG. 14) may beused to secure the accessory channels 112, 114 to the duodenoscope 102.The clips 116 may be spaced apart the entire length of the duodenoscope102, thus ensuring that the accessory channels 112, 114 do not separatesignificantly from the duodenoscope 102. It may be ideal for the clips116 to still permit longitudinal movement of the accessory channels 112,114 along the length of the duodenoscope 102, while restricting orlimiting other movement. For example, clips 116 may be fixedly connectedto accessory channels 112, 114, and slidably connected to the scope 102.While clips 116 are used in this example, a variety of other attachmentmethods may be used such as loops or rings that may be slide along thelength of the duodenoscope 102 to a desired location.

The scope cap 100 may move between a forward-viewing configuration asshown in FIG. 14 and a side-viewing configuration as shown in FIG. 15.To move the scope cap 100 from the forward-viewing configuration to theside-viewing configuration, the accessory channels 112, 114 may beadvanced in a distal direction with respect to the duodenoscope 102 andscope cap 100. This movement results in a force being applied to thepivot arm 104, thereby causing the pivot arm 104 to rotate about thepivot point 106 and thereby move the scope cap 100 into the side-viewingconfiguration as shown in FIG. 15. In the side-viewing configuration,the pivot arm 104 may be rotated about 90 degrees in comparison to theforward-viewing configuration, while the accessory channels 112, 114 maybend away from the duodenoscope 102 and then bend back towards the scopecap 100 substantially perpendicular to the length of the duodenoscope102. Alternatively, the pivot arm 104 may be rotated at a variety ofangles, potentially ranging anywhere from 45 degrees to greater than 135degrees. To facilitate this bend or arch, it may be ideal to provide asufficient amount of space between the most distal clip 116 and thescope cap 100, thus permitting the accessory channels 112, 114 to bendaway from the duodenoscope between the most distal clip 116 and scopecap 100 with minimal restriction. When in the side-viewingconfiguration, an opening 118 in the scope cap 100 may permit tools oraccessories passed through the accessory channels 112, 114 to beadvanced past the scope cap 100.

In use, the scope cap 100 may be used in an ERCP procedure in a mannersimilar to the embodiments described above. The scope cap 100 may bepreinstalled to a duodenoscope 102 or other scope, or a physician orother operator may attach the scope cap 100 and accessory channels 112,114 to any standard, existing scope. The scope cap 100 may be attachedto the distal end of the duodenoscope 102, while the clips 116 may beused to secure the accessory channels 112, 114 to the outside of theduodenoscope 102. The duodenoscope 102, along with the scope cap 100 andaccessory channels 112, 114, may then be inserted into a patient's mouthin the forward-viewing configuration and advanced through thegastrointestinal tract until the scope cap 100 is positioned near thepapilla of Vater. The accessory channels 112, 114 may then be advanceddistally so as to cause the pivot arm 104 to rotate about the pivotpoint 106 and to the side-viewing configuration. Various accessories ortools may then be advanced through the accessory channels 112, 114 andused as desired.

The endoscope system 10 and scope cap 100, or any portions thereof, maybe designed to be disposable, thus reducing the risk of bacterialinfection due to incomplete cleaning between uses.

While the embodiments described herein are shown in reference to theendoscopy field and endoscopic retrograde cholangiopancreatographyprocedures, the embodiments may be used in a variety of other medicalprocedures including endoscopic submucosal dissection and any otherendoscopic procedure that would benefit by having multiple instrumentsat a time and/or the ability to see things from both the forward-viewingand side-viewing perspectives.

The description of the disclosure is merely exemplary in nature and,thus, variations that do not depart from the substance of the disclosureare intended to be within the scope of the disclosure. Such variationsare not to be regarded as a departure from the spirit and scope of thedisclosure.

What is claimed is:
 1. A scope system, comprising: an elongate tubecomprising a lumen extending therethrough, the elongate tube furthercomprising a distal portion; and at least one accessory channelcomprising a tubular structure comprising an accessory lumen extendingtherethrough, the at least one accessory channel movably disposed atleast partially within the lumen of the elongate tube, the at least oneaccessory channel comprising a distal section, the at least oneaccessory channel being movable between a forward-viewing configurationand a side-viewing configuration; wherein in the forward-viewingconfiguration, the distal section of the at least one accessory channelis parallel to the distal portion of the elongate tube; wherein in theside-viewing configuration, the distal section of the at least oneaccessory channel is disposed at an angle relative to the distal portionof the elongate tube; and wherein a camera system is at least partiallyand removably disposed within the accessory lumen.
 2. The scope systemof claim 1, wherein: in the side-viewing configuration, the distalsection of the at least one accessory channel is arced outside the lumenof the distal portion of the elongate tube.
 3. The scope system of claim1, wherein: in the forward-viewing configuration, the distal section ofthe at least one accessory channel is disposed within the lumen of thedistal portion of the elongate tube.
 4. The scope system of claim 1,wherein: movement of a proximal portion of the at least one accessorychannel in a distal direction relative to the elongate tube moves the atleast one accessory channel from the forward-viewing configuration tothe side-viewing configuration.
 5. The scope system of claim 1, wherein:movement of the proximal portion of the at least one accessory channelin a proximal direction relative to the elongate tube moves the at leastone accessory channel from the side-viewing configuration to theforward-viewing configuration.
 6. The scope system of claim 1, wherein:the distal section of the accessory channel is rotatably coupled to thedistal portion of the elongate tube.
 7. The scope system of claim 1,wherein: the distal portion comprises a pivot point, wherein duringmovement of the at least one accessory channel between theforward-viewing configuration and the side-viewing configuration, the atleast one accessory channel rotates about the pivot point.
 8. The scopesystem of claim 1, wherein: the distal portion of the elongate tubecomprises a plurality of individual ribs, at least one of the pluralityof individual ribs comprising a u-shaped cross-section comprising twosides and an opening.
 9. The scope system of claim 8, wherein the twosides are diamond shaped.
 10. The scope system of claim 1, furthercomprising: an axially rotatable bearing disposed between the distalportion of the elongate tube and a proximal portion, the axiallyrotatable bearing permitting rotation of the distal portion with respectto the proximal portion.
 11. The scope system of claim 1, furthercomprising: first and second drive mechanisms connected to the distalportion of the elongate tube and extending proximally along the elongatetube; wherein proximal movement of the first drive mechanism bends thedistal portion of the elongate tube in a first direction, and proximalmovement of the second drive mechanism bends the distal portion of theelongate tube in a second direction.
 12. The scope system of claim 11,wherein: the second direction is opposite the first direction.
 13. Thescope system of claim 11, wherein: the distal portion of the elongatetube comprises a plurality of individual ribs, the first and seconddrive mechanisms connecting the plurality of individual ribs together.14. The scope system of claim 11, further comprising: one or more lightsconnected to the distal portion, wherein one of the first and seconddrive mechanisms further comprises an electrical wiring between thelight and a power source.
 15. The scope system of claim 11, furthercomprising: a third drive mechanism connected to the distal portion ofthe elongate tube and extending proximally along the elongate tube;wherein proximal movement of the third drive mechanism bends the distalportion of the elongate tube in a third direction.
 16. The scope systemof claim 1, wherein: the at least one accessory channel comprises afirst accessory channel and a second accessory channel, wherein thefirst accessory channel is movable between the forward-viewingconfiguration and the side-viewing configuration independent from thesecond accessory channel.
 17. The scope system of claim 1, wherein: theat least one accessory channel comprises a first accessory channel and asecond accessory channel; and the accessory lumen comprises a firstaccessory lumen and a second accessory lumen, the first accessory lumenextending through the first accessory channel and the second accessorylumen extending through the second accessory channel, wherein the camerasystem is at least partially and removably disposed within the firstaccessory lumen.
 18. The scope system of claim 1, wherein: the at leastone accessory channel comprises a first accessory channel and a secondaccessory channel, the accessory lumen comprising a first accessorylumen extending through the first accessory channel and a secondaccessory lumen extending through the second accessory channel, whereinthe camera system is at least partially and removably disposed with thefirst accessory lumen; and the second accessory lumen is configured toreceive one or more endoscopic tools.
 19. A method of using a scopesystem, comprising: inserting the scope system into a patient's body,the scope system comprising an elongate tube comprising a lumenextending therethrough and at least one accessory channel movablydisposed at least partially within the lumen of the elongate tube, theat least one accessory channel comprising a tubular structure comprisingan accessory lumen extending therethrough, wherein a camera system is atleast partially and removably disposed within the accessory lumen;positioning the scope system in a forward-viewing configuration, whereinin the forward-viewing configuration a distal section of the at leastone accessory channel is parallel to a distal portion of the elongatetube; and moving the scope system to a side-viewing configuration,wherein in the side-viewing configuration, the distal section of the atleast one accessory channel is arced outside the lumen of the distalportion of the elongate tube.
 20. The method of claim 19, furthercomprising: moving the scope system from the side-viewing configurationback to the forward-viewing configuration.
 21. The method of claim 19,wherein: the step of moving the scope system to a side-viewingconfiguration further comprises rotating the distal section of theaccessory channel about a pivot point of the distal portion of theelongate tube.
 22. A scope system, comprising: an elongate tubecomprising a lumen extending therethrough, the elongate tube furthercomprising a distal portion; and at least one accessory channelcomprising a tubular structure comprising an accessory lumen extendingtherethrough, the at least one accessory channel movably disposed atleast partially within the lumen of the elongate tube, the at least oneaccessory channel comprising a distal section, the at least oneaccessory channel further comprising a forward-viewing configuration anda side-viewing configuration; wherein in the forward-viewingconfiguration, the distal section of the at least one accessory channelis disposed within the lumen of the distal portion of the elongate tube;wherein in the side-viewing configuration, the distal section of the atleast one accessory channel is arced away from and disposed external tothe lumen of the distal portion of the elongate tube; wherein a camerasystem is at least partially and movably disposed within the distalsection of the accessory channel, the camera system being advanceablebeyond a distal end of the accessory channel.
 23. A scope system,comprising: an elongate tube comprising a lumen extending therethrough,the elongate tube further comprising a distal portion; and at least oneaccessory channel comprising a tubular structure comprising an accessorylumen extending therethrough, the at least one accessory channel movablydisposed at least partially within the lumen of the elongate tube, theat least one accessory channel comprising a distal section that ismovable between a forward-viewing configuration and a side-viewingconfiguration; wherein in the forward-viewing configuration, the distalsection of the at least one accessory channel is aligned with the distalportion of the elongate tube; wherein in the side-viewing configuration,the distal section of the at least one accessory channel is arced awayfrom and relative to the distal portion of the elongate tube; andwherein a camera system is at least partially and movably disposedwithin the distal section of the accessory channel, the camera systembeing advanceable beyond a distal end of the accessory channel.
 24. Ascope system, comprising: an elongate tube comprising a lumen extendingtherethrough, the elongate tube further comprising a distal portion; andat least one accessory channel comprising a tubular structure comprisingan accessory lumen extending therethrough, the at least one accessorychannel movably disposed at least partially within the lumen of theelongate tube, the at least one accessory channel comprising a distalsection, the at least one accessory channel being movable between aforward-viewing configuration and a side-viewing configuration; whereinin the forward-viewing configuration, the distal section of the at leastone accessory channel is parallel to the distal portion of the elongatetube; wherein in the side-viewing configuration, the distal section ofthe at least one accessory channel is arced away from and disposed at anangle relative to the distal portion of the elongate tube; and wherein acamera system is at least partially and movably disposed within thedistal section of the accessory channel, the camera system beingadvanceable beyond a distal end of the accessory channel.
 25. A methodof using a scope system, comprising: inserting the scope system into apatient's body, the scope system comprising an elongate tube comprisinga lumen extending therethrough and at least one accessory channelmovably disposed at least partially within the lumen of the elongatetube, the at least one accessory channel comprising a tubular structurecomprising an accessory lumen extending therethrough, wherein a camerasystem is at least partially and movably disposed within the accessorychannel; positioning the scope system in a forward-viewingconfiguration, wherein in the forward-viewing configuration a distalsection of the at least one accessory channel is parallel to a distalportion of the elongate tube; moving the scope system to a side-viewingconfiguration, wherein in the side-viewing configuration, the distalsection of the at least one accessory channel is arced outside the lumenof the distal portion of the elongate tube; and advancing the camerasystem beyond a distal end of the accessory channel.